Approach to the Patient: Weight Loss Before extensive evaluation is undertaken, it is important to confirm weight loss and to determine the time interval over which it has occurred. Almost half of patients who claim significant weight loss have no actual change when body weight is measured objectively. In the absence of documentation, changes in belt notch position or the fit of clothing may be confirmatory. Not infrequently, patients who have actually sustained significant weight loss are unaware that it has occurred. Routine documentation of weight during office visits is therefore important. The review of systems should focus on signs. | Chapter 041. Weight Loss Part 3 Approach to the Patient Weight Loss Before extensive evaluation is undertaken it is important to confirm weight loss and to determine the time interval over which it has occurred. Almost half of patients who claim significant weight loss have no actual change when body weight is measured objectively. In the absence of documentation changes in belt notch position or the fit of clothing may be confirmatory. Not infrequently patients who have actually sustained significant weight loss are unaware that it has occurred. Routine documentation of weight during office visits is therefore important. The review of systems should focus on signs or symptoms that are associated with disorders that commonly cause weight loss. These include fever pain shortness of breath or cough palpitations and evidence of neurologic disease. Gastrointestinal disturbances including difficulty eating dysphagia anorexia nausea and change in bowel habits should be sought. Travel history use of cigarettes and alcohol and all medications should be reviewed and patients should be questioned about previous illness or surgery as well as diseases in family members. Risk factors for HIV infection should be assessed. Signs of depression evidence of dementia and social factors including financial issues that might affect food intake should be considered. Physical examination should begin with weight determination and documentation of vital signs. The skin should be examined for pallor jaundice turgor scars from prior surgery and stigmata of systemic disease. The search for oral thrush or dental disease thyroid gland enlargement adenopathy and respiratory or cardiac abnormalities and a detailed examination of the abdomen often lead to clues for further evaluation. Rectal examination including prostate examination should be performed in men and all women should have a pelvic examination even if they have had a hysterectomy. Neurologic examination should include mental status .
